How Proposed Changes to the Public Charge Rule Will Affect Health, - PowerPoint PPT Presentation

THE UCLA CENTER FOR HEALTH POLICY RESEARCH The Center’s 2018 Health Policy Seminar Series: How Proposed Changes to the ‘ Public Charge ’ Rule Will Affect Health, Hunger and the Economy in California Ninez Ponce, Laurel Lucia and Tia Shimada November 7, 2018 1

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Today’s Speakers and Funders 3

Overview § Immigrants and the State of California § Public Charge Definition & Proposed Changes § Methods § CalFresh § Medi-Cal § Economic Ripple Effect § Taking Action § Q & A 4

The State of California California has the 5 th largest economy Total Population by Citizenship Status in the world § 38 million people Non-citizen 13% § 27% immigrants (not U.S.-born) § The most Legal Permanent Residents (LPR) Naturalized in the country: ~ 3.3 million citizen 14% § 4 in 10 obtaining LPR status in 2016 from Asia § Mexico top country of origin for new LPRs U.S. born (1 in 4 LPRs) in 2016 citizen 73% Mixed-Status Families • 26% of 9.7 M California children (2.6 million) are U.S. citizens with a non-citizen parent Source: 2015/16 CHIS Source: Current Population Survey from Kaiser Family Foundation March 2018 report on public charge 5

Public Charge: Definition The United States Citizenship and Immigration Services (USCIS) definition of Public Charge: An individual who is likely to become “primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance, or institutionalization for long-term care at government expense.” 6

Public Charge: Current Test Triggers Factors - Age - Health Is a person likely to Receipt of cash become primarily - Family Status assistance or dependent on the - Financial Status institutionalization government for basic - Education & skills for long-term care needs? - Affidavit of support (sponsorship) 7

Public Charge: Current When Who Someone… The public charge test does NOT apply to… - Applies to enter the U.S. LPRs applying for citizenship, refugees, - Applies to become a Legal Permanent Resident (LPR) asylees, survivors of trafficking or domestic violence, among other groups - A Legal Permanent Resident leaves the of non-citizens U.S. for 180 consecutive days & re-enters 8

Public Charge: Proposed Changes Favor the those with higher income… • Only one heavily weighted positive factor: Income ≥250% FPG Work against many others… • Harsher standards for personal circumstances: Children, seniors, and people with limited English proficiency, limited education, medical conditions, large families Threaten health, food security, paths to success • Heavily weighted negative factor: Public benefits including Medi-Cal (Medicaid), Medicare Part D Low-Income Subsidy, CalFresh (SNAP) nutrition assistance, housing assistance 9

Public Charge: Proposed Changes Not retroactive • Public benefits (other than cash assistance and long-term care) received before the proposed rule is finalized will NOT apply Counter to our core values • A nation of immigrants • A state built and thriving on the contributions of immigrants • Stoke fear and confusion 10

Public Charge: Proposed Changes Will harm children and families not legally affected by the changes • A Spanish-speaking mom with a child enrolled in WIC requested that her WIC checks be canceled. She had heard on Telemundo that WIC is a public charge program. She no longer wanted to receive services. (National WIC Association) • A pregnant woman brought in a Korean-language news article titled “If You Receive Food Stamps, You Won’t Get Your Residency.” The article’s subtitle explicitly mentioned WIC. The mother-to-be is on a working visa and fears that she won’t receive a green card as a result of her WIC benefits. (National WIC Association) Entire communities benefit when all have access to food and health care. Entire communities bear the weight when access is withheld. 11

Methods 12

Methods When an enrollee stops Disenrollment participating in a program Disenrollment from public Key Chilling effect programs by qualified enrollees Definitions due to confusion, fear and misinformation Lawful permanent residents or LPR “green card” holders 13

Public Benefits Included in Proposed Public Charge Rule CURRENT PROPOSED ADDITIONS § SSI* § Public assistance § CalFresh (SNAP) § Medicaid/Medi-Cal § Section 8 (Housing § CalWORKS/ for long-term § Medicare Part D Voucher & Rental TANF* institutional care* Low-Income Assistance § Cash assistance Subsidy Program programs) programs* § Subsidized Public Housing *Benefits included in current rule (per Inadmissibility and Deportability on Public Charge Grounds , 1999) 14

Methods Data: CHIS 2015/2016 Individual-level analysis Chilling effect population = Potential disenrollment of individuals who are eligible for the federally-funded benefit Use 2018 $ amounts per enrollee for full-scope Medi-Cal by CHIP: 88% Federal Medicaid children: 50% ACA Expansion: 94% Others: 50% Use 2018 average CalFresh $ benefit level by County: 100% Federal Economic multiplier model: IMPLAN 15

Disenrollment Assumptions: 15%, 25%, 35% Rationale: Studies of welfare reform – The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) – show immigrant disenrollment from public benefits, even when qualified, due to confusion and fear; range of 15%-35% disenrollment for all non- citizen immigrants & mixed-family children, up to 60% for refugees Key studies Fix, M., & Passel, J. (1999). Trends in noncitizens' and citizens' use of public benefits following welfare reform, 1994- § 97. Washington D.C.: Urban Institute. Fix, M., & Passel, J. (2002). The scope and impact of welfare reform's immigrant provisions. Washington D.C.: Urban § Institute. Kandula, N. R., Grogan, C. M., Rathouz, P. J., & Lauderdale, D. S. (2004). The unintended impact of welfare reform on § the Medicaid enrollment of eligible immigrants. Health Serv Res, 39 (5),1509-1526. 16

Defining the population affected All Californians in a household with a non-citizen, with at least one member participating in a public program and/or income below 250% FPL California population of focus for our analysis Californians who may potentially be denied a green card based on public benefit use as proposed in public charge test 17

CalFresh (SNAP) Eligibility of Non-citizen Individuals Household Income up to 130% of Federal Poverty Guidelines (FPG) Non-Citizen Citizen LPR <=5 years LPR >5 years Refugee or Asylee, Citizen child of Hmong/Laotian, non-citizen Child <18 yrs Cuban/Haitian, AI/AN* parent + Direct--Lawfully present Elderly* pending GC application Disabled Undocumented Key: Veterans, active duty military children and adults & other visa Federally-funded CalFresh/SNAP Other lawfully present (worker, student, tourist) State-funded CFAP Not eligible for CalFresh or CFAP *Elderly individuals born on or before 8/22/1931 and who lawfully resided in U.S. on 8/22/1996, AI/AN = American Indian/Alaska Native born abroad Sources :https://www.fns.usda.gov/snap/snap-policy-non-citizen-eligibility, http://calfresh.guide/immigrant-eligibility-for-calfresh-benefits/#qualified

Medi-Cal (Medicaid) Eligibility of Non-citizen Individuals Household income up to 138% of Federal Poverty Guidelines (FPG) for Adults & 266% of Federal Poverty Guidelines (FPG) for children age <19 Citizen Non-Citizen Citizen child of non- LPR >5 Refugee or Asylee, LPR <=5 years citizen parent years Hmong/Laotian, Cuban/Haitian, AI/AN* Child <19 yrs Key: + Direct--Lawfully present pending GC Federally/state-funded full scope Pregnant women applicatio n State-funded full scope with Veterans, active Undocumented federal contribution to duty military Adults & Other emergency/pregnancy services Undocumented Other lawfully Visa (worker, Children, DACA Federally/state-funded partial present student, tourist) scope/emergency only *Elderly individuals born on or before 8/22/1931 and who lawfully resided in U.S. on 8/22/1996, AI/AN = American Indian/Alaska Native born abroad Sources :https://www.fns.usda.gov/snap/snap-policy-non-citizen-eligibility, https://www.dhcs.ca.gov/dataandstats/statistics/Documents/noncitizen_brief_ADAfinal.pdf

State & Substate Estimates Race/Ethnicity Region Latino NORTHERN/SIERRA Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Non-Latino Asian Humboldt, Inyo, Lake, Lassen, Mariposa, Mendocino, Modoc, Mono, Nevada, Plumas, Non-Latino White Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba Non-Latino Other Race SACRAMENTO AREA El Dorado, Placer, Sacramento, Yolo GREATER BAY AREA Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, Sonoma SAN JOAQUIN VALLEY Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, Tulare CENTRAL COAST Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura LOS ANGELES Los Angeles OTHER SOUTHERN CALIFORNIA Imperial, Orange, San Bernardino, San Diego, Riverside 20

CalFresh 21